Quality of post cardiac arrest care - The post arrest consult team
Emergency and Critical Care
A novel, interdisciplinary team (the PACT) was developed and implemented to optimize postcardiac arrest care. The PACT was able to significantly reduce premature withdrawal of life-sustaining therapy in these patients, however improvements in other important aspects of post cardiac arrest care were not observed. Qualitative data collection identified several barriers related to the design and implementation of the team which require attention before broad implementation of this strategy to improve care for post cardiac arrest patients is considered. This is a blended abstract from the quantitative and qualitative components of the study. Both manuscripts have been accepted for publication in peer-reviewed journals. 1) Steven C. Brooks , et al. The post cardiac arrest consult team (PACT): Impact on hospital care processes for out-of-hospital cardiac arrest patients. Critical Care Medicine. Epub Ahead of Print. 2016. 2) Dainty KN, et al. Implementing a Post-Arrest Care Team: Understanding the Nuances of a Team-based Intervention. Implementation Science. In Press.
We evaluated whether a Post-Arrest Consult Team (PACT) improved care and outcomes for patients with out-of-hospital cardiac arrest (OHCA). Design: Prospective cohort study of PACT implementation at 2 hospitals, with concurrent controls from 27 others and a follow up qualitative ethnographic study of PACT health care providers. Patients: We included comatose adult patients with OHCA. Intervention: The Post-Arrest Consult Team was an advisory consult service to improve key post cardiac arrest care processes including targeted temperature management, cardiac assessment and end-of-life decision-making. Measurements and Main Results:We used generalized linear mixed models to explore the association between PACT implementation and performance of targeted processes. We included 1,006 patients. The Post-Arrest Consult Team was associated with a significant reduction over time in rates of withdrawal of life-sustaining therapy within 72 hours of emergency department arrival on the basis of predictions of poor neurologic prognosis (ratio of odds ratios, 0.13; 95% CI, 0.02–0.98). The PACT was not associated with improvements in other important clinical processes including targeted tempearture management. Providers spoke about lack of interaction between team members and a shared sense of purpose, the challenge of off-service consulting and lack of feedback as barriers to effectiveness. Conclusion: PACT had a modest effect on important post arrest processes. Local tailoring, purposefully creating a ‘sense of team’, the team composition and organizational culture and provision of performance feedback might be important facilitators to improve effectiveness of this strategy.